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Milking For All It's Worth

By Scott Hamilton, M.D.
February 10, 2020

This week’s guest columnists are Meghan Gaddis, M.D. and Camtu Nguyen, M.D., Family Practice residents at University Hospital & Clinics.


Nothing’s worse than a crying, inconsolable baby. We face them from time to time in the Pediatric Emergency Department, and this one evening mom was equally frazzled. With hair in a messy bun and eyes teary from lack of sleep, she told us “my baby hasn’t breastfed or taken a bottle since yesterday! I don’t know what to do!” Baby was six days old, and seemed a poor breast feeder due to trouble latching on. This first-time mom maybe wasn’t producing much milk with the latching difficulty, and her level of stress certainly wasn’t helping her supply. To make milk, breasts need stimulation from baby and a calm mom. She was also using a breast
pump to help stimulate supply, but this wasn’t going well, either—on top of that, she was dead set on NOT using formula because, of course, “breast is best.”

However, baby looked pretty darn healthy. Sure he was fussy, but calmed down easily with swaddling and a pacifier. He was rounded out, well fed, hydrated and acting vigorous. Many first-time mothers aren’t aware of the timeline of milk production. The first milk produced immediately after birth is called colostrum. It’s thicker than later breast milk, and has a higher protein content. This “liquid gold” only comes out a teaspoonful at a time, but that’s all baby needs. It provides enough calories while encouraging baby to practice sucking, swallowing and breathing before regular breast milk comes in in quantity. And, believe it or not, newborns’ stomachs are only about the size of a cherry, so a few teaspoons fill baby up just fine! In three to five days, breast milk really comes in. Mom’s breasts begin to feel heavy and full, and baby begins feeding with more vigor. Urine and poop production also ramp up with the increased intake.

Poop goes from the tarry green, sticky “meconium” to a yellow stool that looks like it has oatmeal flakes or “seeds” in it. Isn’t this an enjoyable talk with your morning coffee?

Breast feeding has always had a bit of a stigma. From ancient Egypt to medieval times, nobility considered itself above breast feeding. Royalty often employed wet nurses—mothers who recently weaned their own babies—to feed their little heirs. When 20th century technology brought ordinary people things that only royalty used to have, like indoor plumbing and ready-made meals, it also brought formula. Now, no one has to breast feed. In the beginning, bottle feeding is easier for both mother and baby. As we mentioned last week, latching and sucking takes some training. While bottle feeding, like many other technologies, has the front-end convenience of ease, it creates more problems than it solves. Bottle-fed babies more easily become obese children and adults, with higher risk of diabetes. They have more colic in the first few months. Plus, they get more stomach viruses, colds and ear infections than their breastfed cohort. Then, they’re brought to the Pediatric Emergency Department or their doctor’s offices constipated, infected and miserable.


Breast feeding has many advantages for both moms and babies. Making milk burns calories, and thus moms lose weight faster. Suckling stimulates the release of oxytocin, a hormone that shrinks the uterus to prepregnancy size and reduces bleeding. Plus, breast feeding parents have less to haul around. Traveling with babies has become more like a caravan—car seats, portable cribs, bulging diaper bags, and more—so adding an assortment of bottles, nipples, measuring cups and sterile water on top of that definitely weighs you down. Back to our mom from last week that was worried her little one wasn’t getting enough milk—how can you tell if baby is getting adequate fluids? First, if your baby is crying and wailing, it means they have enough fluids to be active. Tears? Another good sign. The best way to tell is if they’re able to make wet diapers. If you have at least one or two a day, it means they’re definitely getting enough milk!